Domenic Michael Canonico, MD is a medicare enrolled "Otolaryngology - Plastic Surgery Within The Head & Neck" physician in Tullahoma, Tennessee. His current practice location is
507 Nw Atlantic St, Tullahoma, Tennessee. You can reach out to his office (for appointments etc.) via phone at
(931) 393-4332.
Domenic Michael Canonico is licensed to practice in Tennessee (license number 18819) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1770551640.
Physician's Profile
| Full Name | Domenic Michael Canonico |
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| Gender | Male |
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| Speciality | |
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| Experience | Years |
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| Location | 507 Nw Atlantic St, Tullahoma, Tennessee |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Domenic Michael Canonico attended and graduated from in
NPI Data:
- NPI Number: 1770551640
- Provider Enumeration Date: 03/08/2006
- Last Update Date: 07/14/2015
Medicare PECOS Information:
- PECOS PAC ID:
- Enrollment ID:
Medical Identifiers
Medical identifiers for Domenic Michael Canonico such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1770551640 | NPI | - | NPPES |
| 0192943 | Other | TN | BCBS |
| 040013804 | Other | TN | RAILROAD MEDICARE |
| 3085592 | Medicaid | TN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207YX0007X | Otolaryngology - Plastic Surgery Within The Head & Neck | 18819 (Tennessee) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Domenic Michael Canonico is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Domenic Michael Canonico, MD
507 Nw Atlantic St,
Tullahoma, TN 37388-3504
Ph: (931) 393-4332 | Domenic Michael Canonico, MD
507 Nw Atlantic St,
Tullahoma, TN 37388-3504
Ph: (931) 393-4332 |
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